Health policy

Dr Nighat Musa
Assistant Professor
Community Medicine
 Learning objectives
• Define health policy
• Describe its role in health system
• Describe different stages in policy making
• Describe the different types of policies
• Describe the constraints in policy making
• Describe health policy of Pakistan
Brain storming What is
What is public a policy
policy & how Types of
are they
developed
policies

Have you
read any
policy in your
life
?? Role of evidence in
public policy
Why policies
are important
 Definition
• A policy is typically described as a principle
or rule to guide decisions and achieve
rational outcome(s)

• A plan or course of action, as of a

government, political party, or business,
intended to influence and determine
decisions, actions, and other matters
• Reimers and McGinn define policy generally as
………a statement of the actions to be preferred in
the pursuit of one or more objectives of an
organization.
Some languages (e.g., Spanish) use the same word
to refer to policy as to politics.
A recent trend is to define policy as what
organizations do…Some writers treat policy not as
specific solutions to concrete problems but as
frameworks for action (Reimers and McGinn,
1997, p.29)
 • Policy is defined as an explicit or implicit single
decision or group of decisions which may set out
directives for guiding future decisions, initiate or
retard action, or guide implementation of previous
decisions.
• Policy making is the first step in any planning cycle
and planners must appreciate the dynamics of policy
formulation before they can design implementation
and evaluation procedures effectively

Education policy planning process: an applied framework (UNESCO)

 Policy models
• Number of models have been developed to
describe policy
• Some are linear while others capture more
complex and circuitous route of policy
development
• The linear model of policy was developed by
Lasswell (1951) and modified by Meier (1991) to
include four steps taken in policymaking

• Policy practitioners make

predictions/prescriptions about issues that need to
be addressed through policy, policymakers make a
policy choice, the policy is then implemented and
has an outcome.

• This simple framework has no feedback loop or

opportunities for the process to move backward as
well as forward
 Lasswell model

Implementatio
Agenda n
Evaluati
on
alternatives
Linear model (modified)
• To capture the dynamic nature of policymaking,
Grindle and Thomas (1991) suggest a more complex
framework to describe policy development that
includes an agenda phase, a decision phase, and an
implementation phase
• At each stage, the framework suggests that a decision
can be made for or against the policy.
• For example, an issue can either be put on the policy
agenda or not put on the agenda.
• At the decision phase, the decision can be for or
against policy reform.
• At any of the three stages, a policy either continues to
move toward successful implementation, or else it is
overturned.
Stages model of policy making
• A third type of policy model is described in terms of
policy streams.
• Kingdon (1984) suggests that policy change comes
about when three streams—problems, politics, and
policies—connect.
• Kingdon’s model shows that while the three streams
may be operating independently of one another, all
three need to come together in order for a policy to
emerge.
• Each of the streams described by Kingdon has its
own forces acting upon it and ultimately influencing
it.
• The policy streams model focuses on the importance
of the timing and flow of policy actions
 Policy cycle
• In political science the policy cycle is a tool
used for the analyzing of the development of a
policy item. One standardized version
includes the following stages:
1. Agenda setting (Problem identification)
2. Policy Formulation
3. Adoption
4. Implementation
5. Evaluation
 Problem
identification

Policy
Evaluation
formulation
Policy
cycle

Implementation Adoption
• An eight step policy cycle is developed in
detail in The Australian Policy Handbook by
Peter Bridgman and Glyn Davis (2000):

1. Issue identification
2. Policy analysis
3. Policy instrument development
4. Consultation (which permeates the entire process)
5. Coordination
6. Decision
7. Implementation
8. Evaluation
 Issue
Evaluation identification

Policy
Implementation Eight steps analysis
policy cycle

Policy
Decision instrument
development

Consultation
• The Policy Circle uses “P” designations to help
users remember the six main components of
policy.
i. the Problems that arise requiring policy
attention
ii. the People who participate in policy and the
Places they represent
iii. the Process of policymaking
iv. the Price Tag of the policy (the cost of policy
options and how resources are allocated)
v. the Paper produced (actual laws and policies)
vi. the Programs that result from implementing
policies and their Performance in achieving
policy goals and objectives
• Policymaking occurs in varying political, social,
cultural, and economic settings that affect
how policies are developed and implemented.

• The arrows in the Policy Circle join each of the

six components with the other components to
depict the complex and nonlinear nature of
policy.
• Policies are typically promulgated through
official written documents.
• Policy documents often come with the
endorsement or signature of the executive
powers within an organization to legitimize the
policy and demonstrate that it is considered in
force.
• Such documents often have standard formats
that are particular to the organization issuing the
policy. While such formats differ in form, policy
documents usually contain certain standard
components including;
• A purpose statement, outlining why the
organization is issuing the policy, and what its
desired effect or outcome of the policy should be.

• An applicability and scope statement,

describing who the policy affects and which
actions are impacted by the policy. The
applicability and scope may expressly exclude
certain people, organizations, or actions from the
policy requirements. Applicability and scope is
used to focus the policy on only the desired
targets, and avoid unintended consequences
where possible.
• An effective date which indicates when the
policy comes into force.

• Retroactive policies are rare, but can be

found.
• A responsibilities section, indicating which
parties and organizations are responsible for
carrying out individual policy statements.
• Many policies may require the establishment of
some ongoing function or action. For example, a
purchasing policy might specify that a
purchasing office be created to process purchase
requests, and that this office would be
responsible for ongoing actions.
• Responsibilities often include identification of
any relevant oversight and or governance
structures.
• Policy statements indicating the specific
regulations, requirements, or modifications
to organizational behavior that the policy is
creating.
• Policy statements are extremely diverse
depending on the organization and intent,
and may take almost any form.
• Some policies may contain additional sections,
including:

• Background, indicating any reasons, history, and

intent that led to the creation of the policy, which
may be listed as motivating factors. This
information is often quite valuable when policies
must be evaluated or used in ambiguous situations,
just as the intent of a law can be useful to a court
when deciding a case that involves that law.

• Definitions, providing clear and unambiguous

definitions for terms and concepts found in the
policy document.
 Types of policies
• Policies may be classified in many different
ways.
• The following is a sample of several
different types of policies broken down by
their effect on members of the organization.
 Distributive policies

 Regulatory policies

 Constituent policies

 Miscellaneous policies
• Distributive policies

– Distributive policies extend goods and services to

members of an organization, as well as
distributing the costs of the goods/services
amongst the members of the organization.

– Examples include government policies that impact

spending for welfare, public education, highways,
and public safety, or a professional organization's
benefits plan.
• Regulatory policies

– Regulatory policies, or mandates, limit the

discretion of individuals and agencies, or otherwise
compel certain types of behavior.

– These policies are generally thought to be best

applied when good behavior can be easily defined
and bad behavior can be easily regulated and
punished through fines or sanctions.

– An example of a fairly successful public regulatory

policy is that of a speed limit.
• Constituent policies

– Constituent policies create executive power

entities, or deal with laws.

– Constituent policies also deal with Fiscal Policy

in some circumstances.
• Miscellaneous policies

– Policies are dynamic; they are not just static

lists of goals or laws.

– Policy blueprints have to be implemented,

often with unexpected results.

– Social policies are what happens 'on the ground'

when they are implemented, as well as what
happens at the decision making or legislative
stage.
• When the term policy is used, it may also refer
to:
– Official government policy (legislation or guidelines
that govern how laws should be put into operation)

– Broad ideas and goals in political manifestos and

pamphlets

– A company or organization's policy on a particular

topic. For example, the equal opportunity policy of
a company shows that the company aims to treat all
its staff equally.
• The actions the organization actually takes may often
vary significantly from stated policy.

• This difference is sometimes caused by political

compromise over policy, while in other situations it is
caused by lack of policy implementation and
enforcement.

• Implementing policy may have unexpected results,

stemming from a policy whose reach extends further
than the problem it was originally crafted to address.

• Additionally, unpredictable results may arise from

selective or idiosyncratic enforcement of policy
Policies
Communication information Human resource policy
policy
Defense policy Information policy
Domestic policy Macroeconomic policy
Economic policy Monetary policy
Education policy Population policy
Energy policy Public policy in law
Environmental policy Science policy
Foreign policy Security policy
Health policy Transportation policy
Housing policy Urban policy
Company policy Water policy
Privacy policy
HEALTH POLICY
• National health policy 2001 (agenda for
health sector reform)

• National health policy 2009 (stepping

towards better health)

• National health vision Pakistan 2016 – 25

NATIONAL HEALTH VISION
PAKISTAN 2016 – 25
VISION
• To improve the health of all Pakistanis,
particularly women and children by
providing universal access to affordable,
quality, essential health services which are
delivered through a resilient and responsive
health system, capable of attaining the
Sustainable Development Goals and
fulfilling its other global health
responsibilities
OBJECTIVES
• The National Health Vision 2016–2025 has adopted the
following objectives to improve the health and well-being of
the Pakistanis:
• a) Provide a unified vision to improve health while ensuring
provincial autonomy and diversity;
• b) Build coherence between federal and provincial efforts by
consolidating progress, learning from experience, and
moving towards universal health coverage;
• c) Facilitate synchronization across international reporting
and treaties;
• d) Ensure coordination for regulation, information
collection, surveillance, and research on improved health
systems;
• e) Create a foundational basis for charting and
implementing SDGs in partnership with other sectors.
PILLARS
• Governance
• Health financing
• Packaging health services
• Human resource for health
• Health information system and research
• Essential medicine and technology
Role of International health
agency in public health
• Enumerate international health agencies
working in health sector.
• Discuss structure and function of WHO &
UNICEF
• Explain the roles of WHO & UNICEF in
Pakistan
 International health agencies
• World health organization (WHO)
• United Nations Educational, scientific and
cultural organization (UNESCO)
• United Nations population fund activities
(UNFPA)
• United nations development program
(UNDP)
• WORLD Bank
• Swedish international development agency
• Food and agricultural organization (FAO)
• United nations international children emergency
fund (UNICEF)
• Danish international development agency
• European commission
• United states agency international development
(USAID)
• Colombo plan
• International labour organization (ILO)
• International federation of red cross and
red crescent (IFRC)
• International committee of red cross (ICRC)
 Structure & function of WHO & UNICEF
• WHO
• Created on 7th April 1948
• 7th April celebrated as world health day
• Head quarter in Geneva
• Area of work:
– Health system
– Life long health
– Non communicable/communicable diseases
– Preparation, monitoring, response business
services
 Structure & function of WHO & UNICEF
• Goal:
– Achieved by all people of the highest level of
health””
• Structure:
– More than 7000 people work in more than 150
countries
– Six regional offices
– Head quarter in Geneva, Switzerland
• Main bodies
– The world health assembly, the management
board, the secretariate
 Structure & function of WHO & UNICEF
• Function and role:
– Health service development
– Biomedical research
– Prevention and control of specific diseases
– Health statistics
– Cooperation with other agencies
– Family health
– Environmental health
– Health literation and information
 Structure & function of WHO & UNICEF
• UNICEF
• Created in 1946 by United Nations
• Head quarters – United nations, new York
• Services and features:
– Child protection and inclusion
– Child survival
– Education
– Social policy
– UNICEF in emergencies
 Structure & function of WHO & UNICEF
• Services and features:
– Gender
– Innovation for children
– Supply and logistics
– Research and analysis
– Use data to generate results